IASbaba’s Daily Current Affairs – 20th Sep 2017

HEALTH/NATIONAL

Government policies and interventions for development in various sectors and issues arising out of their design and implementation.

Issues relating to development and management of Social Sector/Services relating to Health

Ascertaining quality healthcare

Background:

The death of children in the recent Gorakhpur tragedy has drawn significant attention towards the state of public health institutions in Uttar Pradesh (UP). An analysis shows that within the state, the public health infrastructure is far worse than Gorakhpur in most districts. The disease in the public health system of UP is much worse than symptoms like Gorakhpur reveal.

Misallocation of resources- Case Study:

In terms of CHCs, UP has a suspicious surplus of 190% CHCs compared to what is required. The data shows that most of these CHCs were constructed in 2014 and 2015. These CHCs have a severe shortage of human resources and basic infrastructure. Less than half these CHCs have a functioning X-ray machine. Fundamentally, this suggests gross misallocation of resources and wastage of public funds.

Shortage of human resource and basic infrastrucutre:

There is a drastic shortage of human resources and basic infrastructure required to run public health institutions effectively.

The data from the government’s Rural Health Statistics—2016 shows that there is an overall 84% shortage of specialists, 77% shortage of lab technicians and 89% shortage of radiographers in the CHCs of UP.

There are similar shortages in SCs and PHCs in the state as well.

Almost 91% of the PHCs do not have a lady doctor on duty and 60% do not have a functional operation theatre.

Many of the PHCs and CHCs do not have regular supply of drugs for common ailments.

High incidence of diseases like diarrhoea raises concern about the ability of the public health institutions to treat common ailments such as diarrhoea.

Lowest ranking states:

UP, Bihar, and Jharkhand are the lowest ranked states in terms of overall quantity and quality of public health infrastructure in India. The worst performing districts of Chhattisgarh, which is ranked second among the 21 big states, are comparable to the best performing districts of UP, Bihar and Jharkhand. This disparity across states might have several underlying causes but it also reflects systematic neglect of public health in some states. UP’s per capita public spending on healthcare in 2015-16 was less than half of Chhattisgarh’s. Moreover, within UP, some districts such as Kushinagar have hardly any rural health facilities at all. Citizens probably need to travel to nearby districts for most basic healthcare.

Top ranking states:

In the overall ranking, the top 5 states are Jammu and Kashmir, Chhattisgarh, Gujarat, Karnataka and Rajasthan, while the worst six states are Bihar, Jharkhand, UP, West Bengal, Odisha and Haryana. While Gujarat has relatively lesser quantity of public health infrastructure than Kerala, it has significantly higher quality as measured by availability of doctors, nurses, supply of drugs, etc. This makes the overall condition of public health infrastructure of Gujarat superior to Kerala. Similarly, Delhi has more public health infrastructure than most states, but the relative quality is poorer than several large states.

Governance reforms:

The long-term quality of local public health infrastructure will be fundamentally determined by the governance reforms that we introduce in this sector.

Health being a state subject offers great opportunities for experimentation.

Some states have chosen to empower their medical officers. These states, for example Kerala, have given greater authority for decision-making to their medical officers and also, therefore, hold them more accountable. In many parts of India, however, most local decisions are routed through the district magistrate’s office. This is inefficient and undesirable for sustained improvement of public health institutions in these states. There are several such examples of good governance and best practices available within the country and that could be adopted by the states that are struggling with the knotty problem of poor public health systems.

Conclusion:

While there has been a massive drive to expand the quantity of public health infrastructure in India, particularly in rural areas, the focus must urgently shift to staffing of doctors, nurses, technicians, availability and maintenance of equipment and supply of drugs.

Connecting the dots:

Several examples of good governance and best practices are available within the country in public health systems. These could be adopted by the states that are struggling with the problem of poor public health systems. Discuss.

The Gorakhpur tragedy reveals how grim the situation is when it comes to public health systems in India. Analyze.

ENVIRONMENT

TOPIC:

General Studies 2:

Government policies and interventions for development in various sectors and issues arising out of their design and implementation.

Rethinking on Interlinking of rivers- Part II

Background:

Interlinking of rivers is a very expensive proposal. It has huge adverse environmental impacts on land, forests, biodiversity, rivers and the livelihood of millions of people. It is a socially disruptive proposition. It will not only add to climate change impact (destruction of forests means destruction of carbon sinks, and reservoirs in tropical climate are known sources of methane and carbon dioxide), but will also reduce our capacity to adapt to climate change.

Issues with the Ken-Betwa link:

The link will facilitate export of water from drought-prone Bundelkhand to the upper Betwa basin, as the detailed project report (DPR) makes clear.

The Ken-Betwa link’s hydrology is not known, so there is no way to check if the claim of Ken river being surplus is valid.

There has been no credible environmental impact assessment of the link and no public hearings in canal and downstream affected areas. The link’s environmental management plan is still being prepared.

The Ken-Betwa link threatens about 200 sq. km of the Panna tiger reserve, and with it the Ken river and large parts of Bundelkhand. Yet, it does not have an environment clearance, a final forest clearance, and its wildlife clearance is being scrutinized by the Central-empowered committee appointed by the Supreme Court.

Issues:

The government justifies the river interlinking project by saying that it will provide irrigation, water supply, hydropower and flood control. However, each of this thought of benefits may not be actually achieved.

Providing irrigation:

Most of India’s water benefits, including irrigation, come from groundwater. In fact, in the past two-and-a-half decades, the net national irrigated area from big dams has decreased by about 1.5 million hectares from a peak of 17.79 million ha in 1991-92, according to government data. But in the same period, India’s total irrigated area has gone up—primarily due to groundwater. Groundwater is our water lifeline and whether we like it or not, whether we want it or not, groundwater is going to remain our water lifeline for decades to come. However, our current use of groundwater is not sustainable. The focus of our water resources development should be on how the groundwater lifeline can be sustained. Interlinking of rivers entails a large number of dams that will lead to destruction of rivers, forests, wetlands and local water bodies, which are major groundwater recharge mechanisms. Thus, river interlinking project is likely to create more problems than benefits.

Hydropower:

As far as hydropower is concerned, it is clear that large hydropower projects are no longer a viable option in India. The power minister has repeatedly said in Parliament over the last two years that hydropower projects of over 11,000MW are stuck due to lack of finances and questions over viability. The chief minister of Himachal Pradesh has stated that private developers are exiting the sector as they consider the projects to be non-viable. The situation in Sikkim and Arunachal Pradesh is similar. It costs over Rs10 crore to produce one megawatt of hydropower, which in turn produces less than four million units of electricity. This means the per unit cost of power from such projects is in excess of Rs8 per unit, when there are no takers for power that costs even Rs3 per unit.

Flood control:

While theoretically, a large reservoir can help moderate floods in the downstream areas, our experience on the ground is different. For example, heads of government, state officials, and the Comptroller and Auditor General have on numerous occasions pointed out that big dams such as the Ranganadi dam, the Damodar dams, the Farakka and Bansagar dams, and the Hirakud dam have brought avoidable flood disasters to Assam, West Bengal, Bihar and Odisha, respectively.

When some rivers are flooded it is assumed that the excess of water can easily be transferred to deficit basin. But when the Brahmaputra is in floods, so is the Ganga and all the rivers through which the water needs to be transferred, including the Subarnarekha, the Mahanadi, the Godavari, the Krishna, the Pennar, and so on. So, these transitory rivers won’t be in a position to accept the excess water to pass on to deficit basins.

Seeing groundwater aquifer as storage option:

The other problem with the river interlinking project is that of storing large quantities of waters. Most of the sites suitable for the big reservoirs are in Nepal, Bhutan and in the North-East—and each one has made clear their opposition to big storage reservoirs.

If we can store water during the monsoon, we can make it available in the post monsoon months. The water resources establishment sees big dams as the only storage option. We instead need to focus on the the groundwater aquifer which is the biggest, cheapest, most benign, possibly fastest and most decentralized storage option for India.

Connecting the dots:

What India needs is not interlinking of rivers but something else to achieve water, agriculture and livelihood security. Critically analyze.

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